<form method="post" id="update_account_form">
<h1>Company Information</h1>
<hr />
<br />
<h2>Account Information</h2>
<table class="bTable">
<tr>
<td>Account #</td>
<td> </td>
<td id="account_number">00-00000-0000</td>
</tr>
<tr>
<td>Customer Since:</td>
<td> </td>
<td id="customer_since">12/31/1969</td>
</tr>
</table>
<br />
<h2>Company Information</h2>
<table class="bTable">
<tr>
<td id="company_label">Company:</td>
<td> </td>
<td><input type="text" name="company" size="30" id="company" onChange="validateForm();"></td>
</tr>
<tr>
<td id="address_label">Address: </td>
<td> </td>
<td><input type="TEXT" name="data[address]" size="30" id="address" onChange="validateForm();"></td>
</tr>
<tr>
<td id="address2_label">Address 2:</td>
<td> </td>
<td><input type="TEXT" name="data[address2]" size="30" id="address2" onChange="validateForm();"></td>
</tr>
<tr>
<td id="city_label">City:</td>
<td> </td>
<td><input type="TEXT" name="data[city]" id="city" onChange="validateForm();"></td>
</tr>
<tr>
<td id="state_label">State:</td>
<td> </td>
<td><input type="TEXT" name="data[state]" SIZE="2" id="state" onChange="validateForm();"></td>
</tr>
<tr>
<td id="zipcode_label">Zip Code:</td>
<td> </td>
<td><input type="TEXT" name="data[zipcode]" SIZE="5" id="zipcode" onChange="validateForm();"></td>
</tr>
<tr>
<td id="website_label">Website:</td>
<td> </td>
<td><input type="text" name="data[website]" size="30" id="website" onChange="validateForm();"></td>
<tr>
<tr>
<td> </td>
<td> </td>
<td><input type="submit" value="Update Company Information" id="update_company"/></td>
</tr>
</table>
<br />
<h2>Authorized Contact</h2>
<table class="bTable">
<tr>
<td>Title:</td>
<td> </td>
<td id="title">Title</td>
</tr>
<tr>
<td id="first_name_label">First Name:</td>
<td> </td>
<td id="first_name">First Name</td>
</tr>
<tr>
<td id="last_name_label">Last Name:</td>
<td> </td>
<td id="last_name">Last Name</td>
</tr>
<tr>
<td id="telephone_label">Telephone:</td>
<td> </td>
<td><input type="text" name="telephone" id="telephone" onChange="validateForm();"></td>
</tr>
<tr>
<td id="fax_label">Fax:</td>
<td> </td>
<td><input type="text" name="fax" id="fax" onChange="validateForm();"></td>
</tr>
<tr>
<td id="cell_label">Cell:</td>
<td> </td>
<td><input type="text" name="cell" id="cell" onChange="validateForm();"></td>
</tr>
<tr>
<td id="email_label">E-Mail:</td>
<td> </td>
<td><input type="text" name="email" id="email" onChange="validateForm();" size="30"></td>
</tr>
<tr>
<td colspan="2"></td>
<td><input type="submit" value="Update Authorized Contact" id="update_contact" /></td>
</tr>
</table>
</form>
<script src="/assets/js//user/account/index.js"></script>
